Wednesday, February 5, 2014

When IOP is Not Enough

Danny successfully completed a great residential treatment program, extending his stay from the traditional 30 day to 45 days. He moved into a reputable sober living home, began an Intensive Outpatient Program, attended 12 Step Meetings and worked with a sponsor. In spite of his best efforts, he relapsed before he got his 60 day chip. When asked about his biggest triggers for use, he immediately responded “boredom” and “stress over family relationships”. Danny was eager to re-enter sobriety, however, he felt he needed more support, without returning to residential treatment.

Janet completed residential treatment one year ago. She has been alcohol and drug free, since then, however, mildly depressed. Janet admitted that she has not been “working a program” and has disconnected from her therapeutic supports. Last week Janet lost her job and convinced herself that she could control her drinking. This week the drinking has controlled her.

Danny and Janet’s stories are all too common. Early recovery is a fragile time and many people suffer significant emotional and mental distress making it difficult for them to manage their life in a work, school or home setting. Reality and /or Post -Acute Withdrawal set in just when they are out of the treatment bubble. Unfortunately, they return to their familiar coping mechanism.

While their problems may not warrant a return to residential treatment, clients often need more services than a traditional Intensive Outpatient Program can offer. According to the National Institute on Drug Abuse (NIDA), one of the principles of effective treatment is — “treatment and service plans must be assessed continually and modified as necessary to ensure it meets his or her changing needs.”

A client may require varying combinations of services and treatment components during the course of treatment and recovery. In addition to counseling or psychotherapy, a client may require medication, medical services, family therapy, parenting instruction, vocational rehabilitation or social and legal services.

Depending upon the situation, a Day Treatment or Partial Hospitalization Program (PHP) may be just what is needed to gain insight into their behavior, improve their coping skills and alleviate “boredom.” Returning to their family or sober living home at night, they are able to practice the new skills they have learned while promoting their new found confidence and independence. A renewed commitment to recovery will also benefit concerned family members, as well as Sober Living managers, who are constantly seeking additional ways to provide additional layers of support.

Offered in many different settings, Day Treatment Programs are ideal for those seeking intensive short term structured services. These settings are considered ideal for those who are thought to lack sufficient motivation to continue treatment, have a severe co-morbidity or history of relapse post treatment.

Day Treatment Programs are also indicated for those who are returning to a high risk environment, have limited psycho-social supports or who are not thriving in their intensive outpatient program. Upon completion clients can be returned to their referring Intensive Outpatient Program.

The terms partial hospitalization, day treatment and intensive outpatient programs may be used nearly interchangeably in different parts of the country. The ASAM patient placement criteria defines structured programming in partial hospitalization programs as 20 hours per week and intensive outpatient programs as 9 hours per week. Partial hospitalization programs provide ancillary medical and psychiatric services, whereas intensive outpatient programs may be more variable in the accessibility of these services. Some clients enter these programs directly from the community. These programs can be used as “step-down” programs for those leaving residential settings or “step up” from an intensive outpatient client who has relapsed but does not require medical detox. A client who has entered into a high risk period for relapse, or has experienced an exacerbation of a co-occurring medical or psychiatric symptom would also be likely candidates for a PHP.

PHPs are staffed by therapists, licensed clinical social workers, registered nurses and physicians providing support and treatment with a 24 hour on-call emergency professional.

The treatment components of PHP’s may include some combination of individual and group therapy, vocational and education counseling, family meetings, medical supervision of medication, random drug testing and treatment of co-occurring disorders. Most PHPs meet five days per week from 9am to 3 pm. The most effective programs combine psycho education, psychotherapy and activity or experiential therapy. The experiential therapy assists clients in cultivating different interests in their lives and teaches them how to plan and enjoy their downtime. These therapies can range from art and equine therapy to a community milieu group where clients experience recreational and service opportunities in their new sober world, saying goodbye to boredom as an old familiar trigger.

North Ridge Counseling offers Day Treatment, IOP and groups for addictions and co-occurring issues. 480-878-6987. www.NorthRidgeCounseling.com